RESUMEN
BACKGROUND: Associations between physical health and depression are consistent across cultures among adults up to 65 years of age. In later life, the impact of physical health on depression is much more substantial and may depend on sociocultural factors. AIMS: To examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe. METHOD: Fourteen community-based studies on depression in later life in nine western European countries contributed to a total study sample of 22 570 respondents aged 65 years and older. Measures were harmonized for depressive symptoms (EURO-D scale), functional limitations and chronic physical conditions. RESULTS: In the majority of the participating samples, the association of depressive symptoms with functional disability was stronger than with chronic physical conditions. Associations were slightly more pronounced in the UK and Ireland. CONCLUSIONS: The association between physical health and depressive symptoms in later life is consistent across western Europe.
Asunto(s)
Depresión/etiología , Estado de Salud , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Cognición , Comparación Transcultural , Depresión/epidemiología , Evaluación de la Discapacidad , Europa (Continente)/epidemiología , Femenino , Indicadores de Salud , Humanos , Masculino , Escalas de Valoración PsiquiátricaRESUMEN
BACKGROUND: The protective effects of religion against late life depression may depend on the broader sociocultural environment. This paper examines whether the prevailing religious climate is related to cross-cultural differences of depression in elderly Europeans. METHODS: Two approaches were employed, using data from the EURODEP collaboration. First, associations were studied between church-attendance, religious denomination and depression at the syndrome level for six EURODEP study centres (five countries, N = 8398). Secondly, ecological associations were computed by multi-level analysis between national estimates of religious climate, derived from the European Value Survey and depressive symptoms, for the pooled dataset of 13 EURODEP study centres (11 countries, N = 17,739). RESULTS: In the first study, depression rates were lower among regular church-attenders, most prominently among Roman Catholics. In the second study, fewer depressive symptoms were found among the female elderly in countries, generally Roman Catholic, with high rates of regular church-attendance. Higher levels of depressive symptoms were found among the male elderly in Protestant countries. CONCLUSIONS: Religious practice is associated with less depression in elderly Europeans, both on the individual and the national level. Religious practice, especially when it is embedded within a traditional value-orientation, may facilitate coping with adversity in later life.
Asunto(s)
Comparación Transcultural , Trastorno Depresivo/epidemiología , Religión y Psicología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Europa (Continente)/epidemiología , Femenino , Humanos , Incidencia , Masculino , Medio Social , Valores SocialesRESUMEN
BACKGROUND: Only a few reports investigated the prevalence of depression in intravenous drug-users with HIV infection, including both asymptomatic and symptomatic subjects. In the same group, the association of depression and personality diagnoses was also poorly researched. METHODS: A consecutive sample of intravenous drug-users was collected from patients admitted to an infectious disease clinic, another random sample was taken from out-patients attending a methadone maintenance treatment program. Subjects were first screened with the Hospital Anxiety and Depression Scale, and then all positive subjects were evaluated with the Composite International Diagnostic Interview. Depression was diagnosed according to DSM-IIIR. In-patients were also given a structured personality inventory (Karolinska Psychodynamic Profile). RESULTS: HIV-positive patients had a high rate of depression (major depression 36.2%, dysthymic disorder 7.1%) when compared to HIV-negatives (15.7 and 3.9%, respectively). In-patients had the highest rate of depression, irrespective of HIV clinical staging. A personality disorder was diagnosed in 36% of the sample, but these subjects were no more significantly depressed. LIMITATIONS: Poor detection of depression by the admitting physician may have led to selective hospitalization of patients with both HIV and mood disorder. The composition of the sample may also be biased by the help-seeking behavior of HIV patients who are also depressed. CONCLUSION: Physicians treating AIDS patients should be alerted to the high rate of depression in clinical HIV illness, in order to identify and properly treat depression.
Asunto(s)
Trastorno Depresivo/diagnóstico , Seronegatividad para VIH , Seropositividad para VIH/psicología , Trastornos de la Personalidad/diagnóstico , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Comorbilidad , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Femenino , Seropositividad para VIH/epidemiología , Humanos , Italia/epidemiología , Masculino , Metadona/uso terapéutico , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/psicología , Inventario de Personalidad , Rol del Enfermo , Centros de Tratamiento de Abuso de Sustancias , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/rehabilitaciónRESUMEN
We investigated hospitalization factors in acutely ill patients visited by psychiatrists at home. A series of 100 consecutive calls for psychiatric emergencies of a community mental health centre were investigated with a structured evaluation of psychiatric symptoms and aggressiveness (IEF, GAS, and VSAS). First order interactions were tested, and selected variables were tested with logistic regression analysis. Admission was significantly associated with GAS scores (low scores were found in 92.6% of admitted patients vs. 43.8% of patients not admitted), paranoid delusions (66.7 vs. 39.7%), and lack of social support (70.4 vs. 30.1%). Multivariate analysis confirmed a significant independent effect only for low GAS score and lack of social support. The study replicated some findings from research on hospitalization in emergency wards, while other factors, such as 'diagnosis' and 'suicide risk', were not significant.
Asunto(s)
Servicios Comunitarios de Salud Mental , Servicios de Urgencia Psiquiátrica , Trastornos Mentales/rehabilitación , Enfermedad Aguda , Adolescente , Adulto , Áreas de Influencia de Salud , Femenino , Estudios de Seguimiento , Hospitalización , Visita Domiciliaria , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Admisión del Paciente , Escalas de Valoración Psiquiátrica , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: This is the first report of results from the EURODEP Programme. AIMS: To assess the prevalence of depression judged suitable for intervention in randomised samples of those aged > or = 65 in nine European centres. METHOD: The GMS-AGECAT package. RESULTS: Differences in prevalence are apparent, 8.8% (Iceland) to 236% (Munich). When sub-cases and cases are added together, five high- and four low-scoring centres emerge. Women predominated over men. Proportions of sub-cases to cases revealed striking differences but did not explain prevalence. There was no constant association between prevalence and age. A meta-analysis (n = 13,808) gave an overall prevalence of 12.3%, 14.1% for women and 8.6% for men. CONCLUSIONS: Considerable variation occurs in the levels of depression across Europe, the cause for which is not immediately obvious. Case and sub-case levels taken together show greater variability, suggesting that it is not a matter of case/sub-case selection criteria, which were standardised by computer. Substantial levels of depression are shown but 62-82% of persons had no depressive level. Opportunities for treatment exist.
Asunto(s)
Trastorno Depresivo/epidemiología , Distribución por Edad , Anciano , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Distribución por SexoRESUMEN
BACKGROUND: Stereotypes of older people suggest that they are depressed. AIMS: To examine depression symptoms among people aged > or = 65 in the general population and to ask the following questions. Are there high proportions of depressive symptoms among otherwise well people? Do these levels reflect the prevalence of depression? Do key symptoms vary with age and do they confirm stereotypes? METHOD: Nine centres contributed data from community-based random samples, using standardised methods (GMS-AGECAT package). RESULTS: Proportions of depressive symptoms varied between centres. Some often associated with ageing were rare. Many were more common in women. Low-prevalence centres tended to have fewer symptoms among 'well' people, but there were inconsistencies. Low levels of symptoms among the well population of a centre did not necessarily predict lower levels in the depressed. CONCLUSIONS: Variations in the prevalence of depressive symptoms occurred between centres, not always related to levels of illness. There was no consistent relationship between proportions of symptoms in well persons and cases for all centres. Few symptoms were present in > 60% of the older population--stereotypes of old age were not upheld.
Asunto(s)
Trastorno Depresivo/epidemiología , Estereotipo , Factores de Edad , Anciano , Anciano de 80 o más Años , Comparación Transcultural , Trastorno Depresivo/psicología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Prevalencia , Distribución por SexoRESUMEN
BACKGROUND: In an 11-country European collaboration, 14 population-based surveys included 21,724 subjects aged > or = 65 years. Most participating centres used the Geriatric Mental State (GMS), but other measures were also used. AIMS: To derive from these instruments a common depression symptoms scale, the EURO-D, to allow comparison of risk factor profiles between centres. METHOD: Common items were identified from the instruments. Algorithms for fitting items to GMS were derived by observation of item correspondence or expert opinion. The resulting 12-item scale was checked for internal consistency, criterion validity and uniformity of factor-analytic profile. RESULTS: The EURO-D is internally consistent, capturing the essence of its parent instrument. A two-factor solution seemed appropriate: depression, tearfulness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation). CONCLUSIONS: The EURO-D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.
Asunto(s)
Trastorno Depresivo/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Europa (Continente)/epidemiología , Humanos , Entrevista Psicológica , Prevalencia , Factores de Riesgo , Sensibilidad y Especificidad , Distribución por SexoRESUMEN
BACKGROUND: Data from surveys involving 21,724 subjects aged > or = 65 years were analysed using a harmonised depression symptom scale, the EURO-D. AIMS: To describe and compare the effects of age, gender and mental status on depressive symptoms across Europe. METHOD: We tested for the effects of centre, age, gender and marital status on EURO-D score. Between-centre variance was partitioned according to centre characteristics: region, religion and survey instrument used. RESULTS: EURO-D scores tended to increase with age, women scored higher than men, and widowed and separated subjects scored higher than others. The EURO-D scale could be reduced into two factors: affective suffering, responsible for the gender difference, and motivation, accounting for the positive association with age. CONCLUSIONS: Large between-centre differences in depression symptoms were not explained by demography or by the depression measure used in the survey. Consistent, small effects of age, gender and marital status were observed across Europe. Depression may be overdiagnosed in older persons because of an increase in lack of motivation that may be affectively neutral, and is possibly related to cognitive decline.
Asunto(s)
Trastorno Depresivo/epidemiología , Distribución por Edad , Anciano , Anciano de 80 o más Años , Europa (Continente)/epidemiología , Femenino , Estado de Salud , Humanos , Masculino , Salud Mental , Distribución por Sexo , Factores SexualesRESUMEN
A total of 64 psychiatric patients were tested with the Italian version of the Karolinska Psychodynamic Profile in order to investigate interobserver and test-retest reliability. The mean inter-observer agreement coefficients (rho) ranged from 0.75 to 0.80 with less experienced psychiatrists, while the mean rho value was higher (0.96) with more experienced raters. Test-retest values were good, ranging from 0.53 to 0.93. Overall, reliability was comparable with that reported in the original Swedish study.
Asunto(s)
Trastornos Mentales/diagnóstico , Determinación de la Personalidad , Adulto , Análisis de Varianza , Femenino , Humanos , Pacientes Internos , Italia , Masculino , Trastornos Mentales/terapia , Variaciones Dependientes del Observador , Pacientes Ambulatorios , Determinación de la Personalidad/normas , Psicoterapia/métodos , Reproducibilidad de los ResultadosRESUMEN
The present study was designed to investigate the effect of haloperidol on plasma corticosteroid levels in a small sample of unmediated psychiatric patients requiring acute care. Seven young male normotensive subjects in metabolic balance received a single dose of haloperidol (2 mg i.v.). Blood samples were collected for the radioimmunoassay of plasma renin activity, cortisol and aldosterone concentration at baseline and 3, 6, 12 and 24 h after injection. In five out of seven patients a significant, transient elevation of plasma aldosterone level was observed within 12 h from administration. In contrast, plasma renin activity and cortisol concentration were unchanged. Possible clinical implications of the neuroleptic-associated aldosterone elevations are discussed.
Asunto(s)
Aldosterona/metabolismo , Antipsicóticos/farmacología , Haloperidol/farmacología , Adulto , Antipsicóticos/sangre , Haloperidol/sangre , Humanos , MasculinoRESUMEN
BACKGROUND: We investigated the prevalence of depression among 255 elderly general practice patients and the practitioners' performance in identifying depression. METHOD: Elderly patients attending 14 general practices entered a screening phase with GHQ-12 and MMSE. Those positive were then interviewed with GMS and HAS. RESULTS: DSM-III-R major depression affected 22.4%, dysthymic disorder 6.3%, not otherwise specified (n.o.s.) depression 7.1%. General practitioners performed fairly well: identification index 88.4%, accuracy 0.49, bias 1.85. CONCLUSIONS: Depression was markedly high. A selective progression of depressed elderly from the community to general practitioners is implied.
Asunto(s)
Trastorno Depresivo/epidemiología , Medicina Familiar y Comunitaria , Factores de Edad , Anciano , Competencia Clínica , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/terapia , Medicina Familiar y Comunitaria/normas , Medicina Familiar y Comunitaria/estadística & datos numéricos , Femenino , Evaluación Geriátrica , Humanos , Italia/epidemiología , Masculino , Escalas de Valoración PsiquiátricaRESUMEN
A cross-sectional community survey was undertaken to investigate the pattern of psychotropic drug consumption in 453 community residents of South Verona. Overall, 15.0% of the subjects were taking psychotropics (benzodiazepines 13.5%, antidepressants 2.2%, neuroleptics 1.1%). Prevalence was higher in females (20.0%), in those over 45 years (25%), in high General Health Questionnaire (GHQ) scorers (26.2%), and in subjects with physical ill-health (27.0%), with social problems (20.0%), with distressing events (22.0%) and with alcohol abuse (32.3%). Logistic regression analysis showed that age, sex, GHQ score, physical ill-health and life events were all significantly and independently associated with psychotropic drug consumption.
Asunto(s)
Trastornos Mentales/epidemiología , Psicotrópicos/uso terapéutico , Adolescente , Adulto , Anciano , Estudios Transversales , Utilización de Medicamentos , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/psicología , Persona de Mediana Edad , Análisis Multivariante , Factores de RiesgoRESUMEN
The association of social support with emotional distress in relation to adversities such as social problems, physical health and undesirable life events was assessed in an Italian community sample of 222 men and 224 women. Univariate comparisons and logistic regression analyses showed that neither the quality of a confiding core relationship nor social support from kin confidants was related to adversities. In women only, social support from friend confidants exerted a statistically significant independent main effect together with social problems and undesirable life events in producing a greater probability of emotional distress. The implications of these findings are discussed considering the socio-cultural characteristics of Italian families and individual coping strategies.
Asunto(s)
Acontecimientos que Cambian la Vida , Apoyo Social , Estrés Psicológico , Adaptación Psicológica , Adulto , Femenino , Estado de Salud , Humanos , Italia , Masculino , Salud Mental , Factores Sexuales , Estrés Psicológico/psicologíaRESUMEN
The authors review some studies of the recent psychiatric literature on the elderly medically ill. The large variability in setting, screening instruments, and diagnostic criteria makes comparison of results somehow difficult and probably accounts for the differences in prevalence rates. We also outline methodological issues relating to the standardization of screening instruments and to special features ("pseudodementia", "masked" depression) of psychiatric disorders in old age.
Asunto(s)
Geriatría , Trastornos Mentales/epidemiología , Anciano , Humanos , Trastornos Mentales/complicacionesRESUMEN
The main aim of this study was to construct logistic models of emotional distress (defined as a GHQ-30 score of 6 or greater) in a community sample of 226 men and 225 women. The independent variables included were: sociodemographic characteristics, physical health status, social problems and undesirable life events. Univariate comparisons showed that in both sexes undesirable life events and social problems were associated with emotional distress; in men the presence of physical symptoms and widowed, separated or divorced status also showed such an association. Separate logistic regression models for men and women confirmed the importance of undesirable life events and social problems as predictors for emotional distress. In women there was also a significant interaction effect between the two variables on emotional distress. Sociodemographic characteristics and physical health status did not exert a statistically significant effect in these models.
Asunto(s)
Síntomas Afectivos/psicología , Acontecimientos que Cambian la Vida , Trastornos Psicofisiológicos/psicología , Rol del Enfermo , Ajuste Social , Medio Social , Trastornos Somatomorfos/psicología , Adaptación Psicológica , Adolescente , Adulto , Síntomas Afectivos/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Personalidad , Trastornos Psicofisiológicos/diagnóstico , Factores de Riesgo , Trastornos Somatomorfos/diagnósticoRESUMEN
A review is made of the concept of "pseudodementia" through the main studies of the literature on clinical series. These can be divided in homogeneous and heterogeneous diagnostic series. Some of the main methodological flows of the research on the subject are pointed out and the difficult problem of differential diagnosis between depressive pseudodementia and recent onset organic dementia is discussed.